胰腺切除术后长期存活患者胰腺形态参数、外分泌功能及营养状态的变化及其因果关系研究

Evaluation of pancreatic morphometric parameters, exocrine function, and nutritional status and their causal relationships in long-term survivors following pancreatectomy

SURGERY

影响因子:2.7

分区:医学2区 / 外科2区

发表日期:2024 Oct

作者: Hirofumi Ichida, Hiroshi Imamura, Atsushi Takahashi, Ryuji Yoshioka, Yoshihiro Mise, Yosuke Inoue, Yu Takahashi, Akio Saiura

DOI: 10.1016/j.surg.2024.05.046

摘要

接受胰腺切除术的患者面临胰腺外分泌功能不全和营养不良的风险。然而，这些并发症的发生率及相关危险因素尚未得到充分研究。本研究旨在探讨胰腺形态、胰腺外分泌功能及长期营养状态在胰腺切除术后的变化。我们评估了接受胰十二指肠切除术和远端胰腺切除术患者的营养状态、胰腺形态参数及胰腺外分泌功能。营养状态通过体重变化、身体质量指数（BMI）和骨骼肌质量进行评估。手术时测量胰腺实质的质地、残余胰腺体积和胰腺导管直径。外分泌功能则采用N-苯甲酰-L-酪氨酰-p-氨基苯甲酸排泄试验及脂肪泻和非酒精性脂肪性肝炎的临床表现。我们进一步分析潜在的因果关系。共纳入70例患者，诊断为中度和重度营养不良的患者分别为19例（27%）和15例（21%）。大部分术前营养不良的患者术后仍表现为营养不良。大部分患者在胰腺切除后体重和骨骼肌质量均有不同程度的下降，且在较长时间内仍持续。临床和亚临床胰腺外分泌不全分别在36例（51%）和25例（36%）患者中观察到，胰腺导管腺癌、胰十二指肠切除术、胰管扩张、术前低BMI及胰腺外分泌不全等级均与术后营养不良有关联。胰腺导管腺癌、胰管扩张、胰十二指肠切除术、低术前BMI及胰腺外分泌不全是术后营养不良的危险因素。

Abstract

Patients undergoing pancreatectomy are at risk for pancreatic exocrine insufficiency and malnutrition. However, the incidence of these complications and the associated risk factors have not been sufficiently examined. This study aimed to investigate the changes in pancreatic morphology, pancreatic exocrine function, and long-term nutritional status after pancreatectomy.We assessed the nutritional status, pancreatic morphologic parameters, and pancreatic exocrine function in patients undergoing pancreaticoduodenectomy and distal pancreatectomy. Nutritional status was evaluated on the basis of body weight change, body mass index, and skeletal muscle mass. Pancreatic parenchymal texture at the time of surgery, remnant volume of the pancreatic parenchyma, and diameter of the pancreatic duct were measured. Exocrine function was measured using the N-benzoyl-L-tyrosyl-p-aminobenzoic acid excretion test and the clinical signs of steatorrhea and nonalcoholic steatohepatitis. We then investigated potential causal relationships.Seventy patients were included in the study. Moderate and severe malnutrition were diagnosed in 19 (27%) and 15 patients (21%), respectively. Most patients with malnutrition before surgery were also found to be malnourished postoperatively. Body weight and skeletal muscle mass decreased after pancreatectomy in most patients, even in the longer term. Subclinical and clinical pancreatic exocrine insufficiency was found in 36 (51%) and 25 patients (36%), respectively, and pancreatic ductal adenocarcinoma, pancreaticoduodenectomy, dilated pancreatic duct, low preoperative body mass index, and pancreatic exocrine insufficiency grade were found to contribute to postoperative malnutrition.Pancreatic ductal adenocarcinoma, dilated pancreatic duct, pancreaticoduodenectomy, low preoperative body mass index, and pancreatic exocrine insufficiency were risk factors for postoperative malnutrition.